Provider Demographics
NPI:1235383068
Name:DRISKELL, SANDRA C (LPN)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:C
Last Name:DRISKELL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 K D REVELL RD
Mailing Address - Street 2:
Mailing Address - City:WAUCHULA
Mailing Address - State:FL
Mailing Address - Zip Code:33873-2051
Mailing Address - Country:US
Mailing Address - Phone:863-773-4161
Mailing Address - Fax:863-773-5056
Practice Address - Street 1:2401 US HIGHWAY 17 N
Practice Address - Street 2:
Practice Address - City:WAUCHULA
Practice Address - State:FL
Practice Address - Zip Code:33873-4704
Practice Address - Country:US
Practice Address - Phone:863-773-3147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-06
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9398571163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000254800Medicaid